This protocol applies to individuals diagnosed with HIV/AIDS who have a prior history of long-acting cabotegravir (CAB-LA) use as pre-exposure prophylaxis (PrEP). That prior exposure shapes how antiretroviral therapy (ART) must be selected and initiated.
In patients with a history of CAB-LA use as PrEP, integrase genotypic resistance testing should be performed before starting ART. This step is essential to guide appropriate regimen selection in this population.
Pending the results of integrase genotypic resistance testing, guidelines recommend initiating a pharmacologically boosted antiretroviral regimen specifically chosen to address the implications of prior CAB-LA exposure.
The primary goal is suppression of plasma HIV RNA to below the assay limit of detection — typically achievable by approximately 8 to 12 weeks after ART initiation in adherent patients without resistance mutations to the component drugs.
For people who have a history of CAB-LA use as PrEP, INSTI genotype resistance testing should be performed before starting ART.
For people who have a history of CAB-LA use as PrEP, INSTI genotype resistance testing should be performed before starting ART. If ART is to be started before results of genotypic testing results, the following regimen is recommended: DRV/cc or DRV/r with (TAF or TDF) plus (FTC or 3TC)—pending the results of the genotype test (AIII)
Individuals who are adherent to their ARV regimens and do not harbor resistance mutations to the component drugs can generally achieve viral suppression 8 to 12 weeks after ART initiation or after modification due to virologic failure; rarely, it may take longer in some people.
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